Cardiovascular-kidney-metabolic multimorbidity, mortality and life expectancy in US adults

The impact of increasingly prevalent cardiovascular-kidney-metabolic (CKM) multimorbidity on absolute survival remains unclear. We aimed to assess the association of CKM multimorbidity with mortality and life expectancy in US adults.

We included 46,543 adults (mean age 50.0 years) from NHANES (1999-2018). CKM conditions included type 2 diabetes (T2DM), chronic kidney disease (CKD), and cardiovascular disease (CVD). Over a 9.2-year median follow-up, mortality risk increased sequentially with the number of CKM conditions. Compared to participants without CKM conditions, adjusted hazard ratios for all-cause mortality were 2.59 (95% CI: 2.30-2.92) for T2DM + CKD, 2.27 (1.90-2.72) for T2DM + CVD, 2.69 (2.39-3.04) for CKD + CVD, and 3.57 (3.08-4.14) for all three conditions. Using life table methods, we estimated corresponding reductions in life expectancy at age 50. Compared to the reference group, life expectancy losses were 9.2, 8.8, 13.2, and 17.0 years for individuals with T2DM + CKD, T2DM + CVD, CKD + CVD, and all three conditions, respectively. These profound reductions were predominantly attributable to increased CVD deaths, even among those without baseline CVD.

CKM multimorbidity is independently associated with remarkably reduced life expectancy. Because these life years lost are largely driven by CVD mortality, integrated prevention strategies are urgently needed.